Friday, August 23, 2013

Experience Hurts but Experience Helps

I haven’t been posting my Therapy sessions lately because honestly they’ve been relatively boring. Not much has been going on because my life has been pretty rad. This past week however has been an extremely stressful, extremely shitty week for me. Stressor upon stressor upon stressor for me. Thanks to the tips and techniques I’ve learned over the years I’m handling things just fine though. I’m stressed out, but it’s nothing I can’t handle. One thing at a time. Tomorrow is a new day. There are even bright spots and nothing is all that dire. Yay me! Seriously, I don’t even feel the need for a glass of wine. Talk about progress.

One thing I do still notice is that I have a tendency towards impulsive, er, comforts. You know, sex. With the exception of the obvious man-child I used to live with I’m friends with or on good terms with most of my Exes. I was having a lot of car problems this week and Tech Boy has been helping me out. We’ve been handling the just-friends thing pretty well since I told him I didn’t want to see him anymore in the capacity that we had been. It can be tough though because I do have to admit, when I’m stressed out and feeling very vulnerable there is this very uncharacteristic damsel in distress aspect that wants to come out and take comfort in him. I know there are still feelings for him there. I recognize that. It doesn’t mean we’re right for each other though. That’s the mature reasoning.

 I was doing just fine keeping those thoughts to myself. Especially as I have a new special someone that I’m incredibly excited about and I don’t want to do anything that will screw that up. Until he had a bad evening himself. At first we were just chatting via text. I was trying to ease his unhappiness. He’s like me when things go wrong and is very hard on himself. Much more so than he needs to be. Just normal conversational stuff… until he asked if he could come over: at 11:30p.m. on a work night. Here’s where I have a really warped problem. I wanted so badly to make him feel better; to take care of him; he’s helped me out a few time with my car this week so I had an odd sense of obligation; I missed him; it would be comforting; I was lonely; it would be a really bad idea; I don’t want to lead him on; I’m interested in someone else… and that last one is what I held onto… but he got really pushy and I started feeling really guilty, really guilty that he was feeling so bad. I’m not sure why I felt guilty that he felt bad. It wasn’t my fault that he was having a bad day. I had nothing to do with that except that he was still pining for me and I’d moved on (but he doesn’t know that and I’m not telling him because that’s not very nice). For over 35 minutes I tried to gently persuade him to go to bed, that he shouldn’t come over. I told him flat out that it would only make things harder, that I was tired, he was being pushy, my headspace was really bad and I couldn’t take the pressure, and that I couldn’t handle it. He wouldn’t take ‘no’ for an answer for a while. Finally I got him to listen, but it was a little upsetting. And stressful. I was not expecting that kind of pressure and stress on top of the stress that I’d already had to deal with this week.

Sometimes I wonder if there isn’t an evolutionary advantage to having really bad break ups. When you have nasty splits at least you can hate the person black and never want to see them again. You can be done with them, wash your hands of them, and move on clean. No muss, no fuss. When you end things because it’s the right thing to do for you, but maybe not for the other person, and you try to stay “friends”…. It’s more complicated. One person still has real feelings, and even the person that doesn’t still have the strong feelings, still has some feelings. I don’t hate the guy. I still genuinely care about him. He’s a good person. And not for nothing, but he is strikingly attractive. Seriously, he’s probably the hottest guy I’ve ever dated. Easily. Plus I work with him so I see him all the time so there’s that physical proximity and lizard brain attraction that kicks the hormones on to contend with.  It would be a lot easier if I never saw him and we didn’t get along. Simpler.

I wonder if people ever think about that? Everyone always glorifies the ‘being friends’ thing. I have friends that are extremely annoyed with some of my exes because they are a bit {read: a lot} obsessive all over my social media. Or do, say, things like this. It’s a whole different difficult balance to strike that’s even harder when both of you aren’t trying to strike the same balance.

Feelings don’t just disappear and when you are continuously in each other’s space; those emotions are blurry, they don’t remain clean cut, tensions run a bit high, it’s harder to move on… it makes a very good case for needing a lot of space after relationships end.

How am I having relationship problems with a relationship that, technically, I ended a year ago and I don’t even want? Egads!

I am in no way saying that I wish we had an awful breakup. In the end it’s definitely better to be able to act like adults and be able to remain friendly and civil. I’m just talking out loud, you know? It’s bumpy though. I know he and I will be okay. I’ve already talked to him. He’s apologized and we’re fine. We just need to re-establish our boundaries and re-evaluate where we are… maybe get him a girlfriend ::head desk:: 

On my end, I didn't give in. I stuck to my guns and said no. I remained strong in my boundaries. I wasn't ashamed when I woke up this morning. I have nothing to regret. I didn't panic, I dealt. I did what I was supposed to do and things turned out okay. The world didn't end. How about that?

Wednesday, August 21, 2013

The 10 Essential Limits for Relationships and Borderline Personality

Ready for something new? I know I am! Especially as I have someone new in my life that I’m pretty darn excited about. With a budding new relationship it’s a good time to think about establishing healthy boundaries and limits… establish them from the onset, so things are able to develop in a more trustworthy manner. But even if things haven’t been established this way from the beginning, you can still establish them, albeit with a bit more effort, to create a healthier relationship.

Here are some excellent tips for establishing healthy limits in relationships.

Keep in mind that a limit is not about rules or telling the other person what to do. You can't control their behavior; you can only control your own. Limits are based on your personal values and about what you will do to take care of yourself.

1. No mindreading. Your job is to verbalize your own thoughts, feelings, concerns and preferences. By contrast, assuming you know the other person's thoughts and motivations (e.g., "You think that.." or, "You did this/said
this because....") is almost always guaranteed to get you into trouble. Mindreading is one of the biggest obstacles to effective communication; it is invalidating, provocative, and almost always based on misinterpretations.

One of the easiest ways to piss me off is to assume you know how I’m feeling and then to tell me how I’m feeling about something. Even if you’re correct (which people rarely ever are) please let me state my own emotions. It is not your place to speak for me. I’ll speak for me. You speak for you.

2. Build routines of taking a time out when things begin to get heated. People who are furious simply can't think straight; their brain is so focused on their feelings that logic gets thrown out the window. This is especially true with Borderlines and Narcissists. You can test this yourself. Think about something you said in the moment of anger that you regretted the next day (or week).

Talk about time-outs at a calm time before they are needed, letting your partner know how this will work and assuring him or her that you two will come back to finish the discussion when you are both calmer. (Your partner, of course, has the option of initiating a time out too.) Find a safe place that is sacrosanct to you where no one else can enter when you need to be alone.

Early exits when either of you is beginning to feel a temperature rise prevents unsafe, hurtful mistakes--verbal as well as physical. Take the pot off the stove by removing yourself early on from a situation you may not be able to handle calmly.

Routines are always good. It’s always easier to deal with situations when you have a basic idea of how they will play out. It’s the fear and uncertainty of how things will go that make them so terrifying. If you know that when things get heated, you will take a break, calm down, then revisit the issue, to discuss it in a constructive and loving manner, so both partners can feel safe, and especially so the Borderline partner has less fear of abandonment and rejection, then it is potentially less likely that tempers will fly and hurtful things will be said.

3. Regularly do things you both enjoy and share positive reactions to your partner. The two of you need positive shared time and interactions to keep the relationship connection solid.

Always solid advice for relationships. Too often people forgot to compliment and give positive feedback. You should never stop telling each other the good things.

Positivity makes relationships worth having. The more appreciation, agreement, affection, playfulness, attention, etc you offer each other, the sunnier your relationship will be.  And the more you give, the more you'll get.

4. Focus on what you can do to improve situations rather than criticizing each other. And if you do feel it could be helpful to say something to your partner about what she or he has been doing, offer it as feedback, not as a criticism or complaint. People with personality disorders take criticism very badly, so it doesn't work to change their behavior.

Instead, learn ways to bring up your concerns without being critical and triggering the other person's defenses (well, as much as you can for a person with BPD/NPD). To give feedback offer a when-you statement, as in, "When you xyz, I feel abc"). Especially avoid the phrase, "You make me feel."  That's blame.

                Don’t be critical. This goes for Borderlines and our Loved Ones. We’re often on the defensive from the get go. We do not take criticism well and very quickly feel attacked and provoked. If you want to accomplish something productively you need to learn to work within our boundaries so that we can function productively as well.

Remember that it's not your job to tell your partner what he or she should or shouldn't be doing. It is up to you to be honest about how you react as a consequence of your behavior. Your partner's concern for your feelings will tell you a lot about their capacity to show their love.

Just because you stop criticizing them won't stop them from criticizing and blaming you. It’s important to express yourself, but in these constructive, non-blaming ways.

5. Do not speak with contempt, ever. Studies have shown that couples who communicate contempt for each other are the most likely to break up. This principle is most important with regard to listening. Dismissive or eye-rolling as a form of listening dooms relationships.

Be kind to one another. I know this can be hard, especially when things are getting heated, but that is why it’s good it establish time off.

6. No hostile touching; no putting hands on each other in anger. No threats or hurting property, either. Have a zero tolerance policy. Men, take any physical aggressiveness by your girlfriend or wife seriously; abuse of men is an underreported epidemic. Document, document, document, and be in communication with the police.

Never put your hands on your partner. Even if it is a mild pat, your partner may exaggerate it and make false abuse claims. You may end up in jail and unable to see your children.

No abuse ever. Many of us already have a history of abuse so even threatening gestures can be triggering. Even if you don’t, you don’t want to start now.  I regret not going to the police when I should have. Domestic violence is no joke.  Even once is too much.

7. Each person needs to have his or her own space, private time, and friendships as well as joint ones. Keep up with your friends and family and never become isolated. Isolation is the kiss of death to your confidence level, well-being, and sense of reality. Find at least one friend or counselor you can be honest with about what's going on. You need outside perspective, even if that threatens your partner.

Codependency, enmeshment, and alienation are often problems in very unhealthy relationships. Alienation often comes with abuse. If your partner doesn’t like you having your own friends, throws wild temper tantrums when you go out without them (my Evil-Ex used to throw temper tantrums whenever the attention wasn’t on him), makes you feel guilty when you go out on your own or with others, waits up for you, does things to make you jealous while you’re out, does things to make you afraid to go out in the future, … all things I had to deal with, with him… then this is a sign of an unhealthy attachment style.  

It is absolutely healthy and actually beneficial to have your own independent friends and lives outside of your relationship. It’s impossible to develop a fully trusting relationship without room to actually establish space to trust that person in. If you never let someone out of your sight….

8. Take responsibility for having and managing your own feelings, verbalizing your concerns and preferences, and being responsive to your partner's concerns and preferences.

Two words: personal responsibility. These are two words that we as Borderlines don’t exercise nearly as often as we should… but we need to. Being emotionally volatile is not actually a justifiable excuse. 

I’ve owned up to my bullshit and fortunately I’ve worked on my issues to the extent where I’m pretty much past all of the outbursts and out of control parts. It took time and a lot of inner reflection, self-awareness, and work but it’s completely possible. I am responsible for my actions and my emotions. Don’t get me wrong, I still have my limits, and everyone has periods of justifiable emotional expression, but there are ways to do this that are constructive and not harmful. 

Relationships take two, so in so far as you can be responsive to (not responsible for) your partners needs and concerns, take on what you feel you can… Borderline and Non alike. This is not exclusive to either.

9. Come to a mutual agreement about monogamy (or lack of) so you are honest and on the same page. Do not put up with infidelity (however you define it) that goes against your values. With infidelity, your sense of self-esteem will take a huge nosedive and your marriage/partnership will eventually be in name only. Again, formulate strategies with a therapist [if you have one].

Relationships come in many packages these days. I’ve dabbled in many different types of  relationships, but honestly, and contrary to what I used to believe about myself, monogamy is actually where I find myself happiest. I tend to be too flexible to my partners desires though and this ends up making me resentful and unhappy. I need to be more upfront about my own needs so that I, and ultimately, my partner, can be happier…. Fortunately I’m already working on that ;)

10. Work on problem-solving, not blame, and find win-win solutions so "Your-way" and "Their–way" differences lead to an "Our-way" solution that you both feel good about.

The key to finding win-win solutions is to focus first on identifying your concerns. The solution needs to be responsive to all the concerns of both of you to be fully win-win.

It’s not about one-upping. It’s not about proving you’re the one that is right. When you approach an argument to prove you’re the one that is right, all you do is show that your partner is wrong, which means your relationship is going to lose. You’re in a relationship, together. For a relationship to thrive you want to come to a conclusion where you win together, even if that means putting your ego to the side. This is easier said than done for those of us with BPD and it will take time and practice to defeat the fight-or-flight responses we have had ingrained into our mentality to fend off the shame and anger, but with patience and practice we can approach problems in our relationships from a healthy perspective that is caring and productive.

Too often people worry about being right, instead of taking care of each other. I doubt they mean too. They just get swept up in the moment and instead of fixing the problem it becomes about blaming the other person instead of fixing the problem. It needs to stop being about placing blame, and start being about finding a solution. Criticizing the person, harping on the problem, and who did what and what the person did wrong, is not going to help. Instead try focusing on the end goal and focus on the things you can do to accomplish that.

Establishing these limits and principles is a great start for partners. It likely won't work if you try to accomplish them all of them at the same time. Start with the ones you feel strongest about, and move forward discussing and implementing them one by one.

Tuesday, August 20, 2013

Gender Identity and Sexual Orientation in Women with Borderline Personality Disorder: Part 2

… and now for the good stuff! Let’s see if we agree.

Gender Identity and Sexual Orientation in Women with Borderline Personality Disorder: Part 2

Devita Singh MA1, Shelley McMain PhD2, Kenneth J. Zucker PhD1,*
Article first published online: 3 NOV 2010
The Journal of Sexual Medicine
Volume 8, Issue 2, pages 447–454, February 2011


Table 2 shows descriptive data for the GIDYQ and the RCGI for the women with BPD in the current study (for comparative purposes, Table 2 also shows the mean GIDYQ scores of females with GID and a clinical control group of women from data reported on in Deogracias et al.  and Singh et al.  For the GIDYQ, we identified the percentage of BPD women who met the criterion for caseness as defined by Deogracias et al. and Singh et al., which would require a mean score of ≤3. None of the women with BPD met this criterion for caseness.

We next analyzed the GIDYQ and RCGI as a function of self-labeled sexual orientation. For this analysis, we excluded the six women who self-identified as either asexual or unlabeled. 67% of the BPD participants self-identified as heterosexual and 27% self-identified as either bisexual or lesbian. To compare the heterosexual women with the bisexual and lesbian women, we collapsed the latter two categories. A t-test showed that the self-identified bisexual/lesbian women reported significantly more gender dysphoria on the GIDYQ than did the heterosexual women, t(92) = 2.59, P = 0.011, d = 0.36. The self-identified bisexual/lesbian women also recalled significantly more cross-gender behavior in childhood on the RCGI than did the heterosexual women, t(92) = 2.95, P = 0.004,d = 0.28. For the continuous measure of sexual attraction (excluding five women who indicated that they were not attracted sexually to either men or women), the correlation with the GIDYQ was 0.35 (N = 95, P < 0.001) and the correlation with the RCGI was 0.58 (N = 95,P < 0.001). Across all 100 women, the correlation between the GIDYQ and the RCGI was significant, r(98) = 0.58, P < 0.001.

We next compared the data on women with BPD with the same data on the diagnostically heterogeneous clinical control women reported on by Singh et al.  (see Table 2). On the GIDYQ, a 2 (Group: BPD vs. Clinical Controls) × 2 (Sexual Orientation: heterosexual vs. bisexual/lesbian) analysis of variance revealed a significant main effect for sexual orientation, F(1, 183) = 22.18, P < 0.001, with the non-heterosexual women reporting significantly more gender dysphoria than the heterosexual women. On the RCGI, there was also only a significant main effect for sexual orientation, F(1, 145) = 14.93, P < 0.001, with the non-heterosexual women recalling significantly more cross-gender behavior than the heterosexual women.

In our series of carefully diagnosed women with BPD, we did not detect any strong evidence of marked gender identity confusion or gender dysphoria. Using a well-validated dimensional measure of gender dysphoria, none of the women met the criterion for “caseness,” as defined by a mean score of ≤3. The mean GIDYQ scores for the BPD women in this sample were, on average, comparable to the diagnostically heterogeneous clinical control group of women reported on by Singh et al.  (see Table 2). Thus, our data appear to be reasonably consistent with Wilkinson-Ryan and Westen's finding that clinician ratings of gender identity conflict ranked relatively low among an array of possible indicators of identity disturbance in BPD patients. Therefore, a cautious conclusion is that frank gender dysphoria is not a particularly salient aspect of identity issues that female patients referred for BPD wrestle with.

The results of the present study have some implications for theorizing about the relationship between GID and PDs. Over two decades ago, for example, Lothstein argued that female-to-male transsexualism was “primarily a disorder of the self-system . . . involving an early childhood developmental arrest . . . stemming primarily from borderline personality and narcissistic disorders” (p. 11). Although subsequent research on general patterns of associated psychopathology in adult females with GID suggests somewhat elevated rates compared with normative data, the evidence is far from convincing that there is a gross elevation in BPD. For example, Madeddu, Prunas, and Hartmann identified no case of BPD using the Structured Clinical Interview for DSM-IV (SCID) in a sample of 16 female-to-male transsexuals (see also Lobato et al. ). Although other studies have identified modest elevations of BPD traits among female-to-male transsexuals, there is little indication that the association is specific to GID because many of these studies failed to include clinical control comparison groups. In the present study, starting with a sample of BPD women, there was clearly no evidence at all for GID caseness.

I imagine there are quite a few other variables that they’re not taking into account when it comes to trauma and confusion in transsexual psychology, but yanno, try not to gloss over that too much. Egads.

In our sample of BPD women, 27% self-identified as either bisexual or lesbian, and this metric of sexual orientation correlated quite strongly with our self-reported continuous metric of sexual attraction. The percentage of women who self-identified as either bisexual or lesbian was virtually identical to the percentage reported on by Reich and Zanarini and similar to that of Schulte-Herbr├╝ggen et al.. Given that these percentages are quite elevated when compared with population base rates of a self-reported bisexual or lesbian sexual orientation, how might this finding be interpreted?

If the elevation is veridical, three explanations are plausible.  (1.)The first is that the unique stressors associated with a minority sexual orientation predispose a person to develop BPD.  (2.)The second is that a BPD is related to the development of a minority sexual orientation. Perhaps women with BPD experience a greater fluidity in their sexual interests, more so than unaffected women, and this leads them to explore sexual relations with both men and women and, for some, results in a greater percentage eventually adopting a minority sexual identity.  (3.)A third explanation is that both phenomena are related to a third factor or set of factors, which, at present, are unknown.

So either being Gay/Bi makes you more prone to BPD. (My opinion, probably because people would have experienced more abuse, ostracisim, prejudice, and social struggles in their life do the culture they live in).

Being Borderline makes you more likely to be sexually fluid and open to a more sexually open lifestyle.

            Or, they’re not sure yet. (Perhaps it’s just a coincidence.)

An alternative possibility to a veridical explanation pertains to some kind of referral artifact. It is conceivable, for example, that women with a minority sexual orientation and who have a BPD sought out services at our clinic because it has a reputation within the community as being sensitive to sexual minorities, which perhaps was also the case in Reich and Zanarini's U.S. hospital sample. If this conjecture is correct, then it would argue against any kind of genuine elevation of a minority sexual orientation among women with a BPD. One way to test this hypothesis would be to ascertain sexual orientation in a wider range of people with a BPD, including those identified by epidemiological methods, so that one does not have to rely on clinical samples per se.

In the present study, we found that the BPD women who self-identified as bisexual or lesbian reported significantly more concurrent gender dysphoria on the GIDYQ (but not at the level of “caseness”), and also recalled significantly more childhood cross-gender behavior on the RCGI than did the women who self-identified as heterosexual. It is well-established that childhood gender nonconformity is, on average, more common among bisexual and lesbian women than heterosexual women. Thus, these findings were quite consistent with a much broader literature that has documented an association between sex-typed behavior in childhood and later sexual orientation. There was, however, no indication that this pattern was unique to the women with BPD as we previously observed a similar relation in a diagnostically heterogeneous clinical population of women, none of whom were diagnosed with BPD.

So basically, women with BPD and bisexual/lesbian orientation acted pretty much the same way as their non-personality disordered counterparts when it came to gender dysphoria and childhood gender nonconformity, on average. Which to me, indicates that this, as states earlier, as little to do with personality disorder at all.

The relationship between gender role behavior in childhood and later sexual orientation in our sample of women with BPD carries some clinical implications. If it is indeed the case that a minority sexual orientation is elevated among women with BPD, then it would be important to also obtain in a developmental history information about gender development during childhood. It is well known that pervasive cross-gender behavior in childhood carries the risk of social stigma (e.g., within the peer group) and, when it is present, may function as a psychosocial stressor that could serve as a predisposing factor in the development of BPD.

Ah, however, but if a person is also lesbian/bisexual and predisposed to BPD, being lesbian/bisexual and having indicators of this in childhood by gender roles by exacerbate the problems because the stigmas that crossing these lines create is often difficult for children. And as we know, when a sensitive child prone to BPD is stressed, and constantly surrounded by a stressful environment, not accepted for who they are, pressured to be someone they’re not, this is going to wreak havoc on who they are, and create greater issues of identity down the line.

It can anyways. It’s going to depend on the person. I’ve always been comforted by the fact that I’m not heterosexual. Thought I know countless numbers of people that have not had this experience. Granted my heterosexual experiences have been much more traumatic than my homosexual ones, which perhaps, is what contributes to this. Even though these didn’t occur until years after I started dating both men and women. This is why, as with all things, it’s important to take individuals for who each person is and understand each person’s story and history. We all have our own. 
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